COVID‐19: Guidance for Program Delivery

To all healthcare providers, fitness professionals, and trained community providers who support older adults in the Otago Exercise Program.

Given the social distancing measures in place, we recommend that individuals stop participation in face-to-face group or community OEP classes and continue their exercise program at home.  In working with patients, providers are expected to use good clinical judgement at all times, and this can supersede the specific recommendations in this guidance.

Current Otago Participants should perform their OEP exercises three times a week and walk (in a safe and appropriate location) three times a week for up to thirty minutes.

Participants should continue on their current schedule and share their progress using email, texts or phone calls with the physical therapist who prescribed the program, or the fitness professional or community provider who is supporting participation in the program. Virtual visits with a PT following the Otago schedule should occur before progressing the exercises.

Participants can virtually support each other’s participation in the program, track progress, and share successes using emails, texts or phone calls.

PTs should follow their agency’s policies to offer virtual visits.  These may include recommendations for HIPPA compliant videoconferencing platforms.  Individual or group exercise classes can be offered online as well.  Providers are encouraged to have participants sign a waiver of liability approved by their agency, before joining an online exercise class to acknowledge that some safety risks are possible, as in any exercise class.

New Otago Participants: PTs can perform virtual assessments for new participants.  We strongly recommend that a caregiver is present to help guard during the exercises.  This caregiver should either be someone who lives with the participant or has been in the home routinely so as to minimize the chance of COVID 19 infection.  The assessment should be done with visual and voice connection.  Participants should sign an agency waiver acknowledging safety concerns.

Reimbursement for therapy services for telerehabilitation is changing rapidly during this pandemic.  It is the responsibility of the rehabilitation provider to investigate payment, and comply with licensure and legal requirements in their state.  Please follow these changes through information provided by the American Physical Therapy Association at http://www.apta.org/Telehealth/ and the American Occupational Therapy Association at https://www.aota.org/Practice/Manage/telehealth.aspx.

Best Practices: We highly recommend that you ensure that the following are in place before providing a telehealth visit:

  • Be sure to verify your patient’s identity
  • Understand reimbursement guidelines and required documentation
  • Review your state practice act to make sure that you can provide telerehabilitation under your license
  • Contact your mal-practice insurance provider and make sure that your insurance covers care provided under telehealth.
  • Use a HIPAA compliant telehealth interface. Currently, many insurance companies are loosening this requirement, but it will not stay that way, so planning can be beneficial now.
  • Have an informed consent form that you review with the participants and have them sign it.

Technology:  Things to ensure are in place for a successful telehealth visit:

  • The ability for the participant to access a visual and voice interface with the provider
  • Available wireless services with good connectivity
  • A suitable environment at home to complete the activities.

As always, the complete Otago Exercise Program Manual is available here:

https://www.med.unc.edu/aging/cgwep/files/2018/09/ImplementationGuideforPT.pdf

For those exercising at home, there are several resources to support your efforts:

  1. Demonstration of Strength Videos
  2. Demonstration of Balance Exercises
  3. Example Otago Exercise Program Videos – These are a series of 4 videos (20‐30 minutes each) that lead participants through an Otago Program including warm up, strength, and balance exercises

 

The Otago Exercise ProgramFall has trained health care professionals in 18 countries!  Otago is a series of 17 strength and balance exercises delivered by a Physical Therapist in the home that reduces falls between 35 and 40% for frail older adults. This evidence-based program, developed in New Zealand, calls for PTs to assess, coach and progress patients over the course of six months to one year. Recent research at the University of North Carolina at Chapel Hill School of Medicine and Center for Health Promotion and Disease Prevention shows statistically significant improvement in clinical scores after as little as 8 weeks.1

The Otago Exercise Program is being promoted by the Centers for Disease Control, the Patient Centered Outcomes Research Project and the Administration for Community Living in 16 states.

Find an Otago trained Therapist here

Course Description Find out more about our newly revised self-paced online training 3 CEUs only $35. A new short online course is also available to show how the Otago exercises can be done as part of activities of daily living. Over 8,300 PTs from 18 countries have completed our online training.

Click here if you need to submit a justification for CEUs to your local CEU granting agency.

Shubert, T. E., M. L. Smith, L. Jiang and M. G. Ory (2016). “Disseminating the Otago Exercise Program in the United States: Perceived and Actual Physical Performance Improvements From Participants.” J Appl Gerontol.

The CGWEP also supports the Community Health and Mobility Partnership (CHAMP) program which uses the Otago Exercises.